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That was my Christmas present. We're having a meeting about our new insurance program that's going to save you all sooo much money. Not. I get to spend sixteen dollars less per paycheck, but now my co pay on meds is fifty dollars. That means 250 a month. My joy at how much money I saved knew no bounds.

Hope your news was better than mine.

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Floating through the void in the caress of two giant pink lobsters named Esmerelda and Keith.

We are switching to an HDHP (High Deductible Health Plan) on 1 March. This is essentially the "don't go to the doctor ever plan."

I have to pay $2,000 out of pocket before newer (read that "less") benefits kick in.

I now have to pay 20% of lab costs AFTER I pay that initial $2,000.

I have an increased co-pay on my medications AFTER I pay that initial $2,000.

I am fucked. Royally and completely fucked.

At the meeting, they tried saying it was "consumer-driven" which I know means "we're not paying as much, so shop around for cheaper doctors and medications."

To say nothing of the fact we had to hear about "insurance is like communal money... we all pay in, but if someone needs more health care, then everyone's premiums go up." Bastards.

I went up to the HR woman after the meeting and said, "Hypothetically, if someone is paying $1,300 for a medication that has no generic equivalent... does that person have to pay it out of pocket until the $2,000 deductible is reached?"

Yes.

They also tried to sell us on these Health Savings Accounts ("It's your money forever and ever and ever!")... and they're giving us an initial $500 to "ease the transition" but you know what? I need a lot more than five fucking hundred dollars to cover my fucking medical expenses.

That sucks big time. One of my friends just got called into a meeting the other day and similar to your deal.

I've always put the max in a health care spending account. Usually, these are use it or loose it deals.

If you want to get around this here is what I did:

Put max in the healthcare spending account. It will lower your taxable income.

If you haven't used one before they are a pain, but I would submit all reciepts and get a ck back pretty quickly.

However, you don't want to loose that money. What I've always done and told my friend to do was to put the max possible in the spending account even if you don't plan to use it.

So, at the end of the year before the time runs out go to Lenscrafters and pick out the most expensive frames you can find. It usually took me like 5 pair to get close to $2000. Put em on a credit card and ask for an extra copy of the receipt. Submit one copy to the spending act. and return the frames with the other.

I did this for years. Never a question. It's the only thing I can think of to do under those extreme circumstances. Some may think that this is dishonest, but I don't care. Who's to say I didn't just change my mind? ; )

Oh man, so sorry to hear about these changes that will impact you so much. If I know it wouldn't do any good and only make my blood pressure go sky high, I'd start ranting about the mess our healthcare system is in and how the politicians who have such great medical coverage can't seem to find a way extend the benefits they get to the rest of us.

After this March, I will join the ranks of the uninsured since my current insurance company is pulling out of this area for individual coverage and no other insurance company would want someone like me on their plan. With any luck I'll just get hit by a big bus sometime soon!

Wesley has some good ideas and don't forget that Uncle Samwise let's you deduct some healthcare costs from your taxes. Maybe there is some other company out there you could go to work for that has better benefits...hope so anyway!

ab imo pectore

« Last Edit: February 15, 2007, 04:42:59 PM by Tucsonwoody »

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And I wished for guidance, and I wished for peaceI could see the lightning; somewhere in the eastAnd I wished for affection, and I wished for calmAs I lay there - Nervous in the light of dawn

I've been thinking about doing the max thing. This HSA is always good, even if I switch employers. But I really can't afford to shell out $1,200 for Atripla when I go to the pharmacy... this is what has me kinda freaking out. I'll need to pay that out of pocket (or from the HSA) before I can use the stupid benefits.

I'm thinking of making a doctor's appointment and demanding lots and lots of labs or something.

"Test me for malaria! And see can you platinum coat my virus! Thanks."

I don't feel as bad about my car repair bill today after your story. $1200, I could have gone on a nice little trip. Amex is gona love me ;(

Hmm, well keep in mind that you will be paying 20% of a contract rate so that may not be as bad as you think. For instance if labs are 1000, the insurance company may contract with the lab to pay 200 of that. You'd pay 20% of the 200 or $40. That's just an example.

I'm not sure how going to several labs would help at all?

Isn't that just like a corporation to call it "newer"

Hmm, leme think if I come up w/ some other stuff. We need more insurance people to pipe up with how to work the system, maybe alter your title of thread.

Benj, That is devastating news. I'm sorry your employer sucks. And no raise to off set it? Essentially they're singling out people with conditions, as well as regular folks who will have to basically pay all their own health care in a year. Everybody's screwed.

Insurance companies are getting worse and worse by the day. Here is some ideas that may help. Ask your doctor for samples. As long as there is no generic, drug companies give samples. Get as many as you can. Even if they don't have samples of the more expensive meds, get what you can as far as your other meds. Second, contact the company that makes your meds. They usually have an assistance program. We do it all the time for our patients, and it helps a lot. You get a 90 day supply, but you do have to pick it up at you doctors office. It does require a lot of paperwork on your doctors/staff part, but they should be willing to help you. Third, shop around. Not all pharmacies are created equal. Go online and check out Costco. They are usually the cheapest, get the price of a stock bottle, usually 100 pills. See if the pharmacy you regularly use will match it. Some will, some won't, never hurts to ask. You do not have to have a membership at Costco to use the pharmacy. If I think of other things, I will let you know. Cono

Benj, That is devastating news. I'm sorry your employer sucks. And no raise to off set it? Essentially they're singling out people with conditions, as well as regular folks who will have to basically pay all their own health care in a year. Everybody's screwed. ErnieDo the HSA. Do you qualify for ADAP?

There are people who have worked there for 20 years just because of the health insurance offered... the only reason I stayed there was because of the insurance. The good thing is, I've head that insurance for well over 18 months, so I can't be denied coverage by a new insurance company.

I think I make too much money to qualify for ADAP. Close to $30,000 a year.

We've all been screwed over, essentially... especially since they've given us THIRTEEN DAYS to go over to this system.

Insurance companies are getting worse and worse by the day. Here is some ideas that may help. Ask your doctor for samples. As long as there is no generic, drug companies give samples. Get as many as you can. Even if they don't have samples of the more expensive meds, get what you can as far as your other meds. Second, contact the company that makes your meds. They usually have an assistance program. We do it all the time for our patients, and it helps a lot. You get a 90 day supply, but you do have to pick it up at you doctors office. It does require a lot of paperwork on your doctors/staff part, but they should be willing to help you. Third, shop around. Not all pharmacies are created equal. Go online and check out Costco. They are usually the cheapest, get the price of a stock bottle, usually 100 pills. See if the pharmacy you regularly use will match it. Some will, some won't, never hurts to ask. You do not have to have a membership at Costco to use the pharmacy. If I think of other things, I will let you know. Cono

Thank you so much!

I'm gonna call my doctor tomorrow... I might swing by the Richmond ASO too... I never used it because I had such good insurance and didn't want to take resources away from people who really needed them... but I think the situation's changed somewhat.

You see, this is how the average American worker is being screwed. Just 17 years ago in a job with a little tiny non-profit arts organization all I had was a yearly $200 deductible. I vaguely recall the premium costs (it was Blue Cross) for the office being around $250 per person but I could be wrong. I'm sure medication co-pays were something like $3/generic, $5/non-generic. Oh, and it wasn't an HMO... they'd not been invented yet. You went to whatever fucking doctor you wanted to, and needed no referrals for specialists.

Now remember when HMO's became so in vogue in the mid-90's we were ALL told that it would drive down costs... free market and all. It's all been a huge, monstrous lie. At the same time after the non-profit I went on to work at an architectural office and was part of the decision making in management dealing with negotiating our medical health insurance benefits, so I do know how much premiums skyrocket every year. It's just absurd though that nowadays folks are shelling out $50 prescription copays. These insurance companies are nothing but huge rackets now, with the CEO pocketing billion dollar compensation packages even after being fired. It's truly sickening, and I'm glad I'm on ADAP.

Benj, I don't understand why you do not qualify for ADAP at least for your prescriptions. You can't possibly be pulling a six figure income at the age of 24. What are you paying for your doctor's visits and labs?

I guess I had it lucky in the 90's. My first office reimbursed me for my deductible each year as a benefit, then my next job as part of my agreement to work their I demanded they pay 100% of my medical premium copays. Since I went to the doctor at least once/month he kindly offered never to charge me a cent for anything... and this was one of Manhattan's best HIV doctors, not a clinic. He took the 80% insurance payment on assignment, and all my lab work was paid in full. I wasn't until years later around '00 that I had to start going within an HMO network and pay $25 per office visit, and I'm sure much larger prescription copays but never more than $15 for non-generic.

Some more of my ramblings - do check in with your ASO - they might be able to help. I know at the clinic I go to, one of the people there said they do whatever it takes to make sure people get the meds they need in cases where for whatever reason insurance doesn't cover it. Hopefully your ASO has the same resources and attitude.

Also, if you do checkout some places like Costco's website to see what drugs cost, don't be surprised if they don't list stuff like Atripla (they don't). It doesn't mean they can't get it though which is what Sam's Club here does...I think I am their only Atripla user! And some stores like Walmart have meds available through mail order that you can't get at their stores. It's called their specialty pharmacy at: http://www.walmart.com/catalog/catalog.gsp?cat=538876 - Will keep looking for other ideas and thanks to the others who have posted ideas - am sure they will help others as well.

edited to remove flippant comment -

« Last Edit: February 15, 2007, 06:16:04 PM by Tucsonwoody »

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And I wished for guidance, and I wished for peaceI could see the lightning; somewhere in the eastAnd I wished for affection, and I wished for calmAs I lay there - Nervous in the light of dawn

Very sorry to hear that Benj. I freaked out when I found out about my insurance changes too. My boss said something to the effect of "well can you use generics?" I said "HIV meds don't come that way". She blanched and started to cry.

I got my paystub today and got a raise to cover the difference. Funny how things like that work out sometimes.

Anyway.... I hope you are able to get some assistance or help. I hate insurance companies and everything to do with this mess. Many hugs.

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Floating through the void in the caress of two giant pink lobsters named Esmerelda and Keith.

Wow it's at times like this I feel so lucky to live in the UK. Sorry to hear this. Although to be honest I don't really understand how the healthcare system in the US works, just that it sounds expensive. Can someone explain how it works? I don't understand how you have to keep paying for stuff to basically keep you alive?

You need to have a big sob story with your doctor and ask if they can take what the insurance company pays them "on assignment" and not be billed for the remainders. You'll still be shelling out plenty on lab work.

Definitely sucks. I pay $350 per month for the health insurance, $100 per month for meds, $20 per office call and some odd percent of labs. I recall my last Cd4/VL tests were about $385. I'm just thankful not to pay more and to be able to afford those costs. Your employer should be shot. Its basically a plan that only helps you if you have are hospitalized. I bet management didn't get the same plan.

I am so sorry. I don't have anything really concrete to offer. Get as much as you can from ADAP. In addition to your pills ADAP just might help you with your premiums. I know they do out here in California. Let us know when your ADAP appointment is and we'll all put our heads together and come up with a list of things to cover. (I know in my case, I usually have to tell the counselor what programs are available and what I qualify for.)

I just know when I read shit like this my stomach turns and I just feel miserable.

I PMed you my candid feelings but to avoid public vulgarity I won't repeat them here. You know I'll help in any way I can!! Your employers should be marched to the back brick wall and executed with Uzis, but slowly, starting from their feet to their chests.

It is time for the New American Revolution!! Anarchy would be preferable to the gargantuan bureaucracy we're encumbered with now. Medical care is a basic human right and the U.S.A. is a global disgrace for there to be millions of U.S. citizens who lack access to decent health care.

In solidarity I post these lyrics from Marat/Sade:

4 years after the revolutionand the old kings execution4 years after remember howthose portia took their final bow

String up every aristocratOut with the priests and let then live on their fat

Four years after we started fightingMarat keeps up with his writingFour years after the bastille fellHe still recalls the old battle yell

Down with all of the ruling classThrow all the generals out on their ass

Why do they have the goldWhy do they have the power why why why why whyDo they have the friends at the top

Why do they have the jobs at the top

We've got nothing always had nothingNothing but holes and millions of themLiving in holesDying in holesHoles in our bellies andHoles in our clothes

Four years he fought and he fought unafraidSniffing down traitors by traitors betrayedMarat in the courtroomMarat undergroundSometimes the otter and sometimes the hound

Fighting all the gentry and fighting every priestThe business man the bourgeois the military beastMarat always ready to stifle every schemeOf the sons of the ass licking dying regime

We've got new generals our leaders are newThey sit and they argue and all that they dois sell their own colleaguesAnd ride upon their backsOr jail themOr break themOr give them all the axScreaming in language that no one understandOf the rights that we grab with our own bleeding handsWhen we wiped out the bossesAnd stormed threw the wall of the prison you told us would outlast us all

Another thing to look into: The hospital that I go to has their own assistance program based on income that works on a sliding scale. I would call around to hospitals, ask your doctor if any of your area hospitals offer such a program. If they do, you can get your lab work done through them, then have the results faxed to your doctor if he/she is not part of the hospital.

Don't panic. I know it sucks, and having to deal with insurance is really enough to put you over the edge.

Also, a lot of hospitals offer social workers, and have patient advocates who can help too.

Benj,I see this crap every day. Wes made a great suggestion about using a FSA or HSA to fund your gab on a pre-tax basis.

The real news is this is the not going to change anytime soon. Most insurance companies who sell healthcare coverage to other companies only offer CDHP's and HDHP's to their own employees. You can jump ship and hope the company you end up with does not do the same thing as your current employer. Its a crap shoot in my opinion.

My employer used to sell health insurance and I never paid a dime for coverage and very little or nothing for medication. They sold the business to another company and then offering the "new world" plans geared at those who are not sick. Fortunately, I have a PPO choice and take it. However, I still pay dearly. Between the premium, drugs, labs.....about $9,000 out of pocket each year.

You questioned what a contracted rate is. To give you an example from my last lab bill, I have CIGNA PPO. The doc ran all the usual labs (T-Cells, HIV RNA, CBC Diff) and on and on. The charge for that set of lab work was $1,137.48. The contracted rate the insurance company allowed was cut to $219.83 and I paid my 20% or $43.97. I also have an out of pocket max or stop loss of $2,000 a year. So once I hit this, all my procedures excluding meds are covered at 100%. Since my monthly infusion 20% copay is about $450.00 or so, I reach it by May.

Well, score one for basic human decency. My boss (who's in charge of my department, and not responsible for the health plan switch) is apparently quite worried about how I'm going to fare under this new system. Which is a pleasant surprise, because during the meeting and afterwards, she refused to even look at me. Yeah.

My friend Kiesha spoke with her, and my boss is going to try to see what she can do to help me out right now... if anything. It might not be much, but the effort is definitely appreciated.

Wow. Fucking wow.

In a good way.

And merci beaucoup to everyone's who sent well-wishes and helpful Internets links! You all are absolutely wonderful... and made me smile quite a bit (as well as sleep easier) in this irritating and difficult time.

I went by the ASO in Richmond today, but they were closed. So, I got a lovely 4 mile walk for technically no purpose... but at least I got some exercise and fresh air, so there's that. It is a very nice day here, if a bit cold.

I'm going to see if I can get a government job somehow... at the very least, I still have my current job with some sort of health benefits, as craptacular as they may be... but it's better than nothing. But I'd like to somehow get a job with the state (huzzah for living less than 20 blocks from almost every Commonwealth of Virginia government building!), because civil service seems the way to go.

Again... thank you so much to everyone here.

And if you're single and Canadian and like cats... will you marry me? Si vous Ítes seul et Canadien et aimez les chats... est-ce que vous voudriez m'ťpouser?

... My friend Kiesha spoke with her, and my boss is going to try to see what she can do to help me out right now... if anything. It might not be much, but the effort is definitely appreciated. ...

Huzzah!! Let's hope she can do something tangible!! Give her my email if she wants to solicit donations over the Internet.

It's ironic and disgusting when employers in the medical services field (like aupoint's) slash medical coverage for their own employees. If they "can't afford" decent medical coverage how can anyone else?

Next year if the presidential candidates don't have universal health care in their platforms I'm going to vote for the Socialist party candidate.

Boo

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String up every aristocrat!Out with the priests and let them live on their fat!